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Application for Employment

(click here for application instructions)

Contact Information

First Name Click to see instructions This field requires a selection or entry
Last Name Click to see instructions This field requires a selection or entry
Street Address Click to see instructions This field requires a selection or entry
City Click to see instructions This field requires a selection or entry
State Click to see instructions This field requires a selection or entry
Zip Click to see instructions This field requires a selection or entry
Cell Phone Click to see instructions () - This field requires a selection or entry
Home Phone Click to see instructions () - This field is optional. If an entry is made, it must be a valid entry for this type of field.
Email Click to see instructions This field requires a selection or entry




General Questions

Who (if anyone) referred you to Brush Country Electric? Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
In what State do you hold a driver license? Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Driver License Number Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Driver License Type Click to see instructions This field requires a selection or entry
What position are you applying for? Click to see instructions This field requires a selection or entry
Desired Salary Range (low number) Click to see instructions $ This field requires a selection or entry
Desired Salary Range (high number) Click to see instructions $ This field requires a selection or entry
Salary Range Definition (per hour, per week, per month, per year) Click to see instructions This field requires a selection or entry
Have you ever applied to work at Brush Country Electric before? Click to see instructions Yes No This field requires a selection or entry
Are you at least 18 years of age? Click to see instructions Yes No This field requires a selection or entry
Do you have transportation to and from work? Click to see instructions Yes No This field requires a selection or entry
Are you available to work first shift? Click to see instructions Yes No This field requires a selection or entry
Are you available to work second shift? Click to see instructions Yes No This field requires a selection or entry
Are you available to work third shift? Click to see instructions Yes No This field requires a selection or entry
Are you available to work on weekends if necessary? Click to see instructions Yes No This field requires a selection or entry
Are you available to work overtime if necessary? Click to see instructions Yes No This field requires a selection or entry
If hired... What date are you available to start work? Click to see instructions   Choose the date you are available to start work. This field requires a selection or entry
Are you legally eligible to work in the United States? Click to see instructions This field requires a selection or entry
Are you able to perform the essential job functions of the position you are applying for? (with or without reasonable accommodations) Click to see instructions Yes No This field requires a selection or entry
What (if any) reasonable accommodations would you require? Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.




Skills and Abilities

Skill 1: Description Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Skill 1: Years of Experience Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Skill 1: Ability Level/Rating Click to see instructions 1
2
3
4
5
This field is optional. If an entry is made, it must be a valid entry for this type of field.




Skill 2: Description Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Skill 2: Years of Experience Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Skill 2: Ability Level/Rating Click to see instructions 1
2
3
4
5
This field is optional. If an entry is made, it must be a valid entry for this type of field.




Recent Employment

Employer Name Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Supervisor Name Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Employer Address Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
City Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
State Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Zip Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Job Duties Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Reason for Leaving Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Employment Start Month Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Employment Start Year Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Employment End Month Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Employment End Year Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.




Education

College/University Name Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
College/University Address Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
City Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
State Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Zip Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Did you receive a degree? Click to see instructions Yes No This field is optional. If an entry is made, it must be a valid entry for this type of field.
If yes... What type of degree did you receive? Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.




High School Name Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
High School Address Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
City Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
State Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Zip Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Are you a high school/GED graduate? Click to see instructions Yes No This field is optional. If an entry is made, it must be a valid entry for this type of field.




Other School/Training (graduate, technical, vocational) Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Other School/Training Address Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
City Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
State Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Zip Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Please describe the nature of this school/training and any degrees, certificates, or diplomas received. Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.




Military Service

Have you served in the United States military? Click to see instructions Yes No This field is optional. If an entry is made, it must be a valid entry for this type of field.
If Yes... What branch of service? Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
If Yes... Please list any specialized training that you may have received in the military: Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.




Achievements, Awards and Honors

Please list any achievements, awards or honors that you have received. (From previous employers, schools, colleges, training, military, etc.) Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.




References

Reference Name Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Reference Address Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
City Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
State Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Zip Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Reference Phone Click to see instructions () - This field is optional. If an entry is made, it must be a valid entry for this type of field.
Relationship (employer, supervisor, co-worker, relative, friend, etc.) Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.




Reference Name Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Reference Address Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
City Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
State Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Zip Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Reference Phone Click to see instructions () - This field is optional. If an entry is made, it must be a valid entry for this type of field.
Relationship (employer, supervisor, co-worker, relative, friend, etc.) Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.




Other Information

List any other helpful information that Brush Country Electric may use when considering your application: Click to see instructions This field is optional. If an entry is made, it must be a valid entry for this type of field.
Submit Your Application